Indications for Analysis and Problems of Analyzability

In 1960, Levin (10) published a provocative contribution to the subject of analyzability and the indications for psychoanalysis. He began his paper by asking what the analyst must try to ascertain about a patient during the period of the initial interviews. Genetic formulations cannot then be made because only as a result of the work of the analysis itself, when resistances are being overcome, is recall facilitated and are reconstructions possible. How much should the analyst be influenced by hearing from the patient at the outset of early traumatic events? The significance of the traumatic event cannot be assessed until the analysis has proceeded for some time. What constitutes a traumatic event involves a consideration of the developmental phase in which the event occurred, other factors that have contributed to the patient's neurosis—such as the quantity of affect that accompanied the event—, and the opportunity for discharge at the time of its occurrence. To be sure, that such an event is reported in the initial interview is not without significance. For one thing, it may be something the patient seizes upon to satisfy his need for an 'explanation', and may therefore be regarded as a resistance.

An illustration of the complexity of the problem of what constitutes the trauma in a given situation is given by Anna Freud (1). A child witnessed a fight between her parents resulting in the murder of her mother. Not until later in the analysis was it discovered that what was traumatic for the child was not the killing of the mother but rather that during the fight the mother had frantically shouted at the child to 'get out'. It was